Journal Highlights

Telemedicine is becoming vital in the assessment of diabetic retinopathy (DR), particularly in patients who live in rural areas. Research by Jani et al. suggests that telemedicine does improve the rates of DR evaluation among patients who do not have easy access to an ophthalmologist.

The authors conducted a pre-and postimplementation study at 5 primary care clinics that serve rural and under­served patients in North Carolina. The study included 1,787 adults with dia­betes type 1 or 2 who received primary care at the clinics and underwent reti­nal telescreening to determine the pres­ence and severity of DR. Nonmydriatic fundus images were obtained, which were interpreted remotely by a single retina specialist (a coauthor of the study). Primary outcome measures in­cluded changes in the rates of screening and ophthalmology referrals, percent­age of referrals completed, level of DR detected, and patient characteristics associated with the levels of DR.

Patients with complete data (n = 1,661; mean age, 55 years) were included in the statistical analysis. The mean rate of screening for DR before implemen­tation of the telemedicine program was 25.6%, which increased to 40.4% after implementation. Ninety-three referred patients (60%) completed an ophthalmology referral visit within the 22-month study period.

Older patients, African Americans, and other minorities were more likely to require ophthalmology referral than were their white and/or younger counterparts. The odds of referral also were greater for patients with higher hemoglobin A1c levels, longer duration of diabetes, and systemic comorbidities, notably stroke or kidney disease.

The authors concluded that im­plementing retinal telescreening in primary care clinics increases the rate of evaluation for DR among rural and underserved patients. They inferred that this strategy also may increase access to care among patients with DR requiring treatment. (Also see related commentary by Daniel Shu Wei Ting, MD, PhD, and Gavin Siew Wei Tan, MD, in the same issue.)